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EXPLORING THE RISK OF RED CELL ALLOIMMUNIZATION IN MYELODYSPLASTIC SYNDROMES. TO WHAT EXTEND COULD CYTOGENETIC ANALYSIS AT DIAGNOSIS PREDICT THIS RISK?
Author(s):
Ioannis Koutsavlis
,
Ioannis Koutsavlis
Affiliations:
Haematology,NHS LOTHIAN,Edinburgh,United Kingdom
Jon Falconer
,
Jon Falconer
Affiliations:
Blood Transfusion Service,NHS LOTHIAN,Edinburgh,United Kingdom
Jennifer Fleming
,
Jennifer Fleming
Affiliations:
Cytogenetics Service,NHS LOTHIAN,Edinburgh,United Kingdom
Huw Roddie
Huw Roddie
Affiliations:
Haematology,NHS LOTHIAN,Edinburgh,United Kingdom
(Abstract release date: 05/18/17) EHA Library. I. 05/18/17; 182635; PB1921
Ioannis
Ioannis
Contributions
PDF Abstract
Abstract

Abstract: PB1921

Type: Publication Only

Background
Red cell alloimmunization poses a huge burden for the blood transfusion services as it may be associated with crossmatching difficulties, haemolytic transfusion reactions and potentially severe clinical consequences for the transfused patient. Collectively, alloimmunization appears to be higher in patients with myelodysplasia (MDS) and chronic myelomonocytic leukaemia (CMML) with a rate somewhat around 15%. Identification of patients at risk of developing alloantibodies would be of clinical significance as antigen negative red cells could be crossmatched in advance for use in clinical practice. Largely, studies have failed to predict this cohort of patients and little is known regarding identifiable risk factors.

Aims

To this end, we focused on exploring the cytogenetic profile from patients with MDS and CMML along with demographic characteristics as risk factors for alloimmunization.

Methods

A retrospective analysis was performed in 360 transfused patients with MDS (74.4%) and CMML (25.6%) registered in our local database between 1980 and 2016. Prognostic variables (age, sex, disease subtype) were assessed using a multivariate prediction model in SPSS statistical software. Cytogenetics at diagnosis were available in 228 of the above patients and univariate analysis was performed separately.

Results

The mean age at diagnosis was 73 years (range 20-95) with 58.3% male patients. Overall, 45 patients (12.5%) formed 76 antibodies [68 alloantibodies, 8 autoantibodies] with 42% of them developing more than 1 antibody. 5 additional patients developed autoantibodies without alloantibodies. Alloantibody specificities were as follows: E (22 cases), C (8), K (7), Cw/ Jka/ Kpa (5 cases each), Lua (4), e/ Fya (3 cases each), M (2), c/ D/ Chido/ Bga (1 case each). Collectively, alloantibodies against the Rh and Kell systems encountered in 69% of this cohort. 6 out of 8 patients with anti-C had also developed a second antibody. In a regression model, none of the following variables reached statistical significant level as predictors for immunization; age (p=0.59), sex (p=0.07), MDS WHO subtype (p=1.0).
228 patients had known cytogenetics at diagnosis. Normal profile (46, XY or 46, XX) was encountered in 58.8%. Similarly, univariate analysis of this cohort (normal versus abnormal cytogenetics) showed odds ratio 1.1 with no statistical significant point (p=0.64). Further subgroup analysis was performed to explore whether the risk was increased in patients with poor or very poor cytogenetics as per IPSS-R. Descriptive statistics showed; very good/ good risk cytogenetics 69.7%, intermediate 12.7% and poor/ very poor 17.5%. Logistic regression analysis revealed no association between cytogenetic groups and risk of alloimmunization (p=0.89, p=0.96 and p=0.84 respectively).

Conclusion
The rate of alloimmunization in our cohort of patients was 12.5%, slightly lower compared to published studies. The most common alloantibody found was anti-E. Prognostic variables included in analysis (age, sex, MDS type but also cytogenetic profile) are not significant predictors of alloimmunization and further studies are needed to investigate other possible risk factors. Prophylactic Rh and Kell antigen matched cells, when possible, would be a reasonable strategy until further knowledge is acquired.

Session topic: 10. Myelodysplastic syndromes - Clinical

Keyword(s): transfusion, Myelodysplasia

Abstract: PB1921

Type: Publication Only

Background
Red cell alloimmunization poses a huge burden for the blood transfusion services as it may be associated with crossmatching difficulties, haemolytic transfusion reactions and potentially severe clinical consequences for the transfused patient. Collectively, alloimmunization appears to be higher in patients with myelodysplasia (MDS) and chronic myelomonocytic leukaemia (CMML) with a rate somewhat around 15%. Identification of patients at risk of developing alloantibodies would be of clinical significance as antigen negative red cells could be crossmatched in advance for use in clinical practice. Largely, studies have failed to predict this cohort of patients and little is known regarding identifiable risk factors.

Aims

To this end, we focused on exploring the cytogenetic profile from patients with MDS and CMML along with demographic characteristics as risk factors for alloimmunization.

Methods

A retrospective analysis was performed in 360 transfused patients with MDS (74.4%) and CMML (25.6%) registered in our local database between 1980 and 2016. Prognostic variables (age, sex, disease subtype) were assessed using a multivariate prediction model in SPSS statistical software. Cytogenetics at diagnosis were available in 228 of the above patients and univariate analysis was performed separately.

Results

The mean age at diagnosis was 73 years (range 20-95) with 58.3% male patients. Overall, 45 patients (12.5%) formed 76 antibodies [68 alloantibodies, 8 autoantibodies] with 42% of them developing more than 1 antibody. 5 additional patients developed autoantibodies without alloantibodies. Alloantibody specificities were as follows: E (22 cases), C (8), K (7), Cw/ Jka/ Kpa (5 cases each), Lua (4), e/ Fya (3 cases each), M (2), c/ D/ Chido/ Bga (1 case each). Collectively, alloantibodies against the Rh and Kell systems encountered in 69% of this cohort. 6 out of 8 patients with anti-C had also developed a second antibody. In a regression model, none of the following variables reached statistical significant level as predictors for immunization; age (p=0.59), sex (p=0.07), MDS WHO subtype (p=1.0).
228 patients had known cytogenetics at diagnosis. Normal profile (46, XY or 46, XX) was encountered in 58.8%. Similarly, univariate analysis of this cohort (normal versus abnormal cytogenetics) showed odds ratio 1.1 with no statistical significant point (p=0.64). Further subgroup analysis was performed to explore whether the risk was increased in patients with poor or very poor cytogenetics as per IPSS-R. Descriptive statistics showed; very good/ good risk cytogenetics 69.7%, intermediate 12.7% and poor/ very poor 17.5%. Logistic regression analysis revealed no association between cytogenetic groups and risk of alloimmunization (p=0.89, p=0.96 and p=0.84 respectively).

Conclusion
The rate of alloimmunization in our cohort of patients was 12.5%, slightly lower compared to published studies. The most common alloantibody found was anti-E. Prognostic variables included in analysis (age, sex, MDS type but also cytogenetic profile) are not significant predictors of alloimmunization and further studies are needed to investigate other possible risk factors. Prophylactic Rh and Kell antigen matched cells, when possible, would be a reasonable strategy until further knowledge is acquired.

Session topic: 10. Myelodysplastic syndromes - Clinical

Keyword(s): transfusion, Myelodysplasia

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